CCR Template - Colorado Secretary of State



DEPARTMENT OF REGULATORY AGENCIES

DIVISION OF INSURANCE

3 CCR 702-4

LIFE, ACCIDENT AND HEALTH

PROPOSED NEW REGULATION 4-2-61

CONCERNING THE PAYMENT PARAMETERS FOR THE COLORADO REINSURANCE PROGRAM

Section 1 Authority

Section 2 Scope and Purpose

Section 3 Applicability

Section 4 Definitions

Section 5 Payment Parameters for the 2020 Plan Year Reinsurance Program

Section 6 Severability

Section 7 Enforcement

Section 8 Effective Date

Section 9 History

Section 1 Authority

This regulation is promulgated and adopted by the Commissioner of Insurance under the authority of §§ 10-1-109(1), 10-16-109, and 10-16-1104(1)(i), C.R.S.

Section 2 Scope and Purpose

The purpose of this regulation is to establish the payment parameters, including the attachment point, coinsurance rate, and program cap, for the Colorado reinsurance program. Establishing these payment parameters ensures that carriers are able to file rates that reflect the impact of the reinsurance program on claims costs. This regulation replaces Colorado Emergency Regulation 19-E-01 in its entirety.

Section 3 Applicability

This regulation applies to all carriers marketing and issuing non-grandfathered individual health benefit plans on or after the effective date of this regulation and that are subject to the individual health benefit plan laws of Colorado.

Section 4 Definitions

A. “Attachment point” shall have the same meaning as found at § 10-16-1103(1), C.R.S.

B. “Carrier” shall have the same meaning as found at § 10-16-102(8), C.R.S.

C. “Coinsurance rate” shall have the same meaning as found at § 10-16-1103(3), C.R.S.

D. “Eligible carrier” shall have the same meaning as found at § 10-16-1103(5), C.R.S.

E. “Geographic area” means, for the purposes of this regulation, the geographic rating area selected by Colorado and approved by the federal government, to be used by carriers in the state of Colorado.

F. “Health benefit plan” shall have the same meaning as found at § 10-16-102(32), C.R.S.

G. “Payment parameters” shall have the same meaning as found at § 10-16-1103(9), C.R.S.

H. “Reinsurance cap” shall have the same meaning as found at § 10-16-1103(10), C.R.S.

I. “Reinsurance payment” shall have the same meaning as found at § 10-16-1103(11), C.R.S.

J. “Reinsurance program” shall have the same meaning as found at § 10-16-1103(12), C.R.S.

Section 5 Payment Parameters for the 2020 Plan Year Reinsurance Program

A. Reinsurance payments shall only be made to an eligible carrier for those individual health benefit plan claims that meet the payment parameters established in this regulation.

B. Colorado has established nine (9) geographic areas for health benefit plans that are contained in the following table:

|Geographic Area |County |

|Geographic Area 1 |Boulder |

|Geographic Area 2 |El Paso, Teller |

|Geographic Area 3 |Adams, Arapahoe, Broomfield, Clear Creek, Denver, Douglas, Elbert, Gilpin, Jefferson, |

| |Park |

|Geographic Area 4 |Larimer |

|Geographic Area 5 |Mesa |

|Geographic Area 6 |Weld |

|Geographic Area 7 |Pueblo |

|Geographic Area 8 (East) |Alamosa, Baca, Bent, Chaffee, Cheyenne, Conejos, Costilla, Crowley, Custer, Fremont, |

| |Huerfano, Kiowa, Kit Carson, Las Animas, Lincoln, Logan, Mineral, Morgan, Otero, |

| |Phillips, Prowers, Rio Grande, Saguache, Sedgwick, Washington, Yuma |

|Geographic Area 9 (West) |Archuleta, Delta, Dolores, Eagle, Garfield, Grand, Gunnison, Hinsdale, Jackson, La Plata,|

| |Lake, Moffat, Montezuma, Montrose, Ouray, Pitkin, Rio Blanco, Routt, San Juan, San |

| |Miguel, Summit |

C. Attachment Points

1. Geographic areas five and nine shall have an attachment point of $30,000.

2. Geographic areas four, six, seven, and eight shall have an attachment point of $30,000.

3. Geographic areas one, two, and three shall have an attachment point of $30,000.

D. Coinsurance Rates

1. Geographic areas five and nine shall have a coinsurance rate of eighty-five percent (85%).

2. Geographic areas four, six, seven, and eight shall have a coinsurance rate of fifty percent (50%).

3. Geographic areas one, two, and three shall have a coinsurance rate of forty-five percent (45%).

E. Reinsurance Caps

1. Geographic area five and nine shall have a reinsurance cap of $400,000.

2. Geographic areas four, six, seven, and eight shall a reinsurance cap of $400,000.

3. Geographic areas one, two, and three shall have a reinsurance cap of $400,000.

Section 6 Severability

If any provision of this regulation or the application of it to any person or circumstances is for any reason held to be invalid, the remainder of this regulation shall not be affected.

Section 7 Enforcement

Noncompliance with this regulation may result in the imposition of any of the sanctions made available in the Colorado statutes pertaining to the business of insurance, or other laws, which include the imposition of civil penalties, issuance of cease and desist orders, and/or suspensions or revocation of license, subject to the requirements of due process.

Section 8 Effective Date

This regulation shall become effective October 1, 2019.

Section 9 History

Emergency regulation 19-E-01 effective May 31, 2019.

Regulation effective October 1, 2019.

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